title: Effectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: a systematic review and meta-analysis of 13 studies.
abstract: BACKGROUND
  Restriction of elbow mobility is a very frequent complaint after trauma or surgery. The objective of this study was to assess and compare the effectiveness of dynamic, static, or static-progressive bracing in patients with elbow stiffness of traumatic or postoperative origin and without evidence of ossification. For the purpose of this study, effectiveness was measured as the increase in total range of motion, as well as extension and flexion.
  
  
  METHODS
  We performed a systematic search of the keywords "elbow AND (stiffness OR stiff) AND (brace OR splint OR conservative)" in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. We included all clinical studies using dynamic or static bracing in patients with elbow stiffness. Eligible outcomes were changes in total range of motion, flexion, and extension; sustainability of results; and complications.
  
  
  RESULTS
  We included 13 eligible studies, providing data on 14 treated groups in 247 patients. The mean age of these patients was 34.5 ± 10.4 years, and female patients comprised 46% ± 12%. The mean duration from the incident to the start of brace treatment was 6.9 ± 5.1 months. The mean improvement in range of motion during the course of treatment was 38.4° ± 8.9° (95% confidence interval, 39.5°-41.8°).
  
  
  CONCLUSIONS
  The current evidence strongly supports the use of static-progressive stretching 3 times 30 minutes per day in each direction as a first line of treatment in patients with post-traumatic and postsurgical elbow stiffness. If this treatment fails or if reasons for stiffness other than soft-tissue incompliance are identified, further surgical interventions should be considered.
authors.affiliation: Orthopaedic Department, University Hospital of Basel, University of Basel, Basel, Switzerland.
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Müller
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
authors.forename: Robert
authors.initials: R
authors.lastname: Lucas
authors.forename: Laurent
authors.initials: L
authors.lastname: Audige
authors.forename: Ruth
authors.initials: R
authors.lastname: Delaney
authors.forename: Maria
authors.initials: M
authors.lastname: Klein
authors.forename: Victor
authors.initials: V
authors.lastname: Valderrabano
authors.forename: Patrick
authors.initials: P
authors.lastname: Vavken
mesh_terms: D000328:Adult; D001915:Braces; D004551:Elbow Joint; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000628:therapy*; D008297:Male; D052580:Muscle Stretching Exercises; D016059:Range of Motion, Articular; D012149:Restraint, Physical; D016896:Treatment Outcome
keywords: Elbow; Level IV; Systematic Review; brace; conservative; stiffness